Understanding Orthobiologics

March 27, 2018 | Gregg P. Hartman, MD

You may have heard on the radio or read on other websites very promising guarantees and sales pitches about orthobiologics but that is not our goal here. What we are presenting is some basic information about these treatments that are based on the current clinical data. These injections are not for everybody and should not be offered to just anyone. Our goal is to give you an introduction of orthobiologics with the hope that, by the end, you will have a better understanding of the treatments.

WHAT ARE ORTHOBIOLOGICS?
We are entering a very exciting time in medicine, specifically in orthopedics. For years, we have been telling our patients that there is nothing that can be done to stimulate healing or slow down the progression of arthritis. But now, we are actually starting to understand different processes of how to stimulate the body to heal itself.

Orthobiologics is the term which represents all of the treatments used to stimulate healing. The main goals of these treatments are to promote new tissue growth, preserve the tissue that is already there, decrease pain and improve function. They are natural treatments, meaning we are not using drugs or chemicals, but are often using your own tissue or occasionally commercially prepared injections in order to promote healing. If you are bone on bone, the injections will not get your body to grow new cartilage but they can still decrease your pain and improve both your function and quality of life.

WHAT ARE THE DIFFERENT KINDS OF ORTHOBIOLOGICS?
Let's break this down into a few categories that we'll discuss below: oral medications and supplements, hyaluronic acid (HA) injections, platelet-rich plasma (PRP) injections and stem cell injections.

Oral Medications and Supplements
A very frequent question from our patients is, “Do glucosamine/chondroitin pills work?” They do not work on everyone but you are welcome to try them. The pills have been shown to increase the proteins in the cartilage and decrease the chemicals that breakdown the joint. They are non-prescription which makes them easy to find and have very few interactions with other medications, but you should check with your pharmacist or primary physician before starting any new medication and/or supplement.

Hyaluronic Acid Injections
Hyaluronic acid (HA) is a natural product that is made inside of your body. It is available as a pill without a prescription, but there is little evidence that there is any real benefit. Where we have seen success in all the major joints is with injections. The injection is put into the joint and has an immediate lubricating effect. Furthermore, for a number of months after the injection, HA can help promote your own joint to produce a better, more viscous fluid.

Platelet-Rich Plasma Injections
Platelet-rich plasma (PRP) is a component of blood and are not true stem cells. This is an injection that uses your own plasma, platelets and growth factors (which are inside the platelets) to promote healing. There are different kinds of PRP injections, some with low white blood cell count and some with high white blood cell count, each used for different reasons. In general, these injections have been shown to promote healing of the tissues and the health of the cartilage as well as create a local healing environment.

Stem Cell Injections
Stem cells are cells that have not yet been turned into a specific type of tissue. There are basically two kinds of stem cells; amniotic stem cells, which are from fetal tissue, or your own stem cells, which are taken from your bone marrow. The fetal tissue is a commercially available product which has been shown to really promote healing and the ingrowth of new blood supply into tissues. The bone marrow stem cells have been shown to be effective in decreasing pain in the joints, but at this point, statistical data is lacking.

DOES MY INSURANCE COVER THE TREATMENTS?
Some of the treatments are covered by insurance companies and some are not. This depends on the type of treatment, the frequency of the injections and the body part or joint needing the treatment. For example, HA injections are covered by some insurance companies but only for the knee. For those treatments not covered by insurance, we believe you will find that our pricing is very competitive and reasonable when compared to other providers.

DOES IT ALWAYS WORK?
The honest answer is no, it does not always work. We are using these treatments to stimulate your own body to heal itself, but how your body responds to the treatments is, unfortunately, unpredictable. There are some good indications for the various treatment options and trends that suggest which patients and which problems respond to the treatments but there are no guarantees.

At Ventura Orthopedics, we are dedicated to providing patients with the latest advances in technology and are proud to serve as the premier destination for orthobiologic treatments. Our orthopedic physicians would love to talk with you about the different treatment options and help you explore whether or not orthobiologics is a solution that could work for you. To schedule an appointment with one of our specialists at a location near you, call us at 800.698.1280.